Unusual clinical course, Challenging differential diagnosis
Georges Tanios, Ines M. Aranguren, Jack S. Goldstein, Chirag B. Patel
Department of Internal Medicine, East Tennessee State University James H. Quillen College of Medicine, Johnson City, USA
Am J Case Rep 2013; 14:518-525
Background: B cell lymphoma constitutes 80–85% of cases of Non Hodgkin’s lymphoma in the Untied States. Metabolic complications may arise from the disease itself or through its end organ involvement.
Case Report: We describe a case of a diffuse large B cell lymphoma diagnosed by abdominal computed tomography after it initially presented as hypoglycemia not correctable by dextrose infusion that instead resulted in increased anion gap metabolic acidosis with elevated lactate levels.
Conclusions: The case illustrates how lymphomas can present unusually with hypoglycemia and lactic acidosis, the latter being an ominous sign that can occur without liver involvement. In this regard, the case demonstrates the metabolic sequelae of lymphoma that should raise suspicion for an underlying process. This has implications for diagnosis, treatment, and patient survival. Attention should be paid especially in the primary care setting in order to minimize delays in diagnosis.
Keywords: Warburg effect, lactic acidosis, Non Hodgkin’s lymphoma, Hypoglycemia, B-cell lymphoma